Abstract
Background:
Medical students are losing hands-on experience during surgical clerkships, and residents and faculty are expected to teach them with minimal educational training. A multilevel cadaveric curriculum (MCC) was implemented to improve surgical education for all groups.
Methods:
In the MCC, a senior resident verbally guided 2 medical students through a procedure on a cadaver, whereas a junior resident performed the procedure on the contralateral side under faculty guidance. Educational benefits were assessed via pre- and postsurveys, with costs shared between surgical departments.
Results:
Six MCC laboratory sessions were performed from 2023 to 2024, with a survey response rate of 89.6% (173 of 193). The laboratory sessions increased medical students’ confidence in identifying procedural anatomy (3.9 versus 5.3, P < 0.0001), using surgical instruments (4.3 versus 5.3, P < 0.0001), and assisting in the operating room (4.8 versus 5.6, P < 0.0001). Both junior and senior residents, respectively, noted increased confidence in marking incisions (3.1 versus 5.6, P < 0.0001; 4.9 versus 6.2, P < 0.0001), identifying neurovascular structures (2.7 versus 5.1, P < 0.0001; 4.6 versus 6.0, P < 0.0001), completing procedures (2.0 versus 4.3, P < 0.0001; 4.0 versus 5.6, P < 0.0001), and teaching medical students (2.1 versus 4.3, P < 0.0001; 3.8 versus 5.5, P < 0.0001). Faculty reported an increase in overall confidence in teaching ability (6.2 versus 6.5, P = 0.006) and providing feedback (6.2 versus 6.5, P = 0.032).
Conclusions:
This laboratory was a beneficial educational experience for medical students, residents, and faculty, with improved cadaveric access achieved through cost sharing.
Takeaways
Question: How can we improve cadaveric education for medical students, residents, and faculty?
Findings: A multilevel cadaveric curriculum was implemented in which a senior resident verbally guided 2 medical students through a procedure on a cadaver, whereas a junior resident performed the procedure on the contralateral side under faculty guidance. Pre- and post-laboratory surveys, residency milestones, and evaluations revealed educational benefits for all groups. Costs were shared between surgical departments.
Meaning: Peer cadaveric learning is an effective educational model that improves cadaveric access to all groups via cost sharing.
INTRODUCTION
The needs of learners in medical education are constantly changing. During the past decade, medical institutions across the United States have decreased anatomy laboratory access, resulting in poorer performance on clinical anatomy examinations among medical students.1–3 Additionally, medical students are losing hands-on experience during surgical clerkships, which may discourage them from applying to surgical residencies or reduce the skills of those who choose this field.4–6 Residents have also been shown to improve anatomical and procedural knowledge with cadaveric teaching models, but do not have consistent access to these programs, given the expense and difficulty of maintaining cadavers.7–11 Both residents and faculty members are expected to teach medical students without formalized curricula.12–17 Despite the desire to improve teaching ability, real-time feedback is lacking in the current educational space, with no existing longitudinal model for faculty development in teaching.18–21
Although medical education has been undergoing reform to match the changing demands of the medical profession, cadaveric dissection has remained a gold-standard teaching tool for learners of all levels in various specialties.4–6,22,23 Medical schools with mandatory cadaveric dissections produce more graduates pursuing surgical subspecialties22 and provide residents a safe space to “see one, do one, teach one.”24 No studies have investigated the use of cadaveric teaching tools for faculty or the benefits of collaborative, multilevel learning environments.
We implemented a novel teaching model to optimize cadaveric education in which a postgraduate year 4–6 (senior) surgical resident verbally guided 2 third-year medical students through a plastic surgery procedure on 1 side of a soft-embalmed cadaver, whereas a postgraduate year 1–3 (junior) resident performed the procedure on the contralateral side under faculty guidance (Fig. 1). Following the event, the student/teacher pairs provided individualized survey-based feedback. Through this multilevel cadaveric curriculum (MCC) (including medical students, residents, and faculty members), we aimed to simultaneously increase the anatomical knowledge, technical skills, and surgical mentorship of medical students, while also honing the teaching ability of residents and faculty through personalized, 2-way education. The program resulted in a resource-conscious educational experience that improves surgical education and provides a model for sharing the associated costs of proper cadaveric stewardship.
Fig. 1.
Example of the setup for the MCC, with faculty and a junior (PGY1–3) resident on 1 side of the cadaver and medical students paired with a senior (PGY4–6) on the other side. PGY, postgraduate year.
MATERIALS AND METHODS
Cadaveric Laboratories
A total of 6 cadaveric laboratory sessions (Table 1) were performed in the 2023–2024 academic year after institutional review board approval, with 6 soft-embalmed cadavers used per session. Cadaveric donation via the willed body program at our institution explicitly permits the use of cadavers in this manner. Cadavers were purchased through a cost-sharing model between the plastic surgery and general surgery departments. Each session lasted a total of 2 hours and consisted of a 20-minute interactive case presentation related to the laboratory procedure, followed by a 10-minute demonstration on a cadaveric prosection (which was dissected by the junior resident under faculty guidance before medical students arrived). Medical students were then divided into pairs to learn how to gown and glove, while the remainder of the residents and faculty arrived for the session. One senior resident then verbally guided 2 medical students through the procedure on 1 side of the cadaver, whereas a faculty member verbally guided a junior resident on the other side for the remaining time, with a total of 12 clinical medical students, 12–13 residents, and 5–6 faculty members per laboratory. The laboratory was a mandatory event for plastic surgery residents and occurred during regularly scheduled resident didactic sessions. By using the existing protected educational time, which faculty are encouraged to attend, minimal clinical work was missed. Medical students were selected for participation via lottery from a pool of interested students during their third-year surgical clerkship. Junior resident–faculty pairs and medical student–senior resident pairs provided individualized, 2-way feedback at the end of each laboratory session using prelaboratory and postlaboratory surveys.
Table 1.
Clinical Scenarios and the Associated Procedures Performed During the 2023–2024 Academic Year in Cadaveric Laboratories
| Clinical Scenario | Procedure |
|---|---|
| Maxillary vascular malformation | Osteocutaneous radial forearm flap |
| Facial skin cancer | Facial flaps (eg, forehead flap, Tenzel flap, Abbe lip switch) |
| Traumatic pan-brachial plexus injury | Free functional gracilis flap |
| Squamous cell carcinoma of the mandible | Subscapular system flaps (ie, parascapular and latissimus dorsi) |
| Thumb arthritis | Carpometacarpal arthroplasty, De Quervain release |
| Infected knee prosthesis | Lower extremity flaps (gastrocnemius, soleus) |
Statistical Methods
Matched 7-point Likert-scale prelaboratory and postlaboratory surveys were distributed to all groups to assess the benefits of laboratory sessions. Institutional review board–approved surveys were used to assess anatomical knowledge, technical ability, and confidence in seeking surgical mentorship among medical students. Resident surveys focused on procedural and teaching ability, whereas faculty surveys focused on teaching alone. Comparisons between the prelaboratory and postlaboratory survey responses of the medical students and resident groups were analyzed with paired-sample t tests, with a significance level defined as P less than 0.05.25,26
Medical student anatomical knowledge was further assessed via the National Board of Medical Examiners (NBME) surgery subject examination, with subsequent NBME scores of participants compared with those of students who did not participate. Resident surgical knowledge and teaching ability were assessed via semiannual resident milestone evaluations, with resident evaluations given before the MCC serving as the control group. These evaluations are given each year to residents based on the Accreditation Council for Graduate Medical Education Plastic Surgery Milestones. Faculty teaching ability was assessed via evaluations submitted by residents, with the comparison group consisting of faculty evaluations before MCC implementation. Paired-sample t tests were used to compare pre- and post-MCC faculty teaching ability, and 2-sample t tests were used for resident evaluations by comparing the performance of the current residents and those from the previous academic year.
RESULTS
The total survey response rate was 89.6% (173 of 193) for all laboratories, with rates of 81.3% (65 of 80) for medical students, 100% (39 of 39) for junior residents, 97.7% (43 of 44) for senior residents, and 86.7% (26 of 30) for faculty.
Medical Students
Medical students reported increased confidence using basic surgical instruments (4.3 versus 5.3, P < 0.0001), suturing (4.7 versus 5.6, P < 0.0001), and assisting in the operating room (OR) (4.8 versus 5.6, P < 0.0001). For a full breakdown of medical students’ Likert-scale data, refer to Table 2. Despite medical students reporting increased confidence in their anatomical knowledge (3.6 versus 5.3, P < 0.0001), there was no significant difference between NBME surgical clerkship shelf scores of medical students who participated in the laboratory compared with those who volunteered but were not selected (mean 76.7 ± 8.0 versus mean 77.1 ± 9.2; P = 0.93). For reference, a score of 77% on the examination corresponded to a student scoring in the 64th percentile of all medical students who took this shelf examination.
Table 2.
Prelaboratory and Postlaboratory Surveys of Medical Students, With Answers Based on a 7-point Likert Scale
| Prelaboratory, Mean (SD) | Postlaboratory, Mean (SD) | P | |
|---|---|---|---|
| Surgeons are good teachers | 5.7 (1.0) | 6.3 (0.6) | <0.0001 |
| Surgeons respect medical students | 5.3 (1.2) | 6.1 (0.9) | <0.0001 |
| I am interested in pursuing a surgical career | 5.9 (1.7) | 5.9 (1.6) | 1.0 |
| I understand the scope of plastic surgery | 4.8 (1.5) | 5.4 (1.2) | <0.0001 |
| I am interested in becoming a plastic surgeon | 4.8 (1.9) | 4.9 (1.8) | 0.13 |
| I am confident that I know the anatomical structures involved in the procedure | 3.6 (1.6) | 5.3 (1.2) | <0.0001 |
| I am confident in my ability to recognize anatomical structures during this procedure | 3.9 (1.4) | 5.3 (1.1) | <0.0001 |
| I am confident in my ability to participate in OR procedures | 4.8 (1.4) | 5.6 (1.0) | <0.0001 |
| I am confident in identify surgical instruments and their function | 4.3 (1.6) | 5.3 (1.2) | <0.0001 |
| I am confident in my ability to use a scalpel | 4.9 (1.6) | 5.7 (1.0) | <0.0001 |
| I am confident in my ability to suture | 4.7 (1.5) | 5.6 (1.2) | <0.0001 |
| I am confident in my ability to instrument tie | 4.7 (1.9) | 5.8 (1.4) | <0.0001 |
| I am confident in my ability to hand tie | 4.3 (1.9) | 4.8 (1.7) | 0.010 |
| I am confident in my ability to staple | 5.3 (1.6) | 5.9 (1.2) | 0.0009 |
| I am comfortable interacting with plastic surgery residents | 5.3 (1.2) | 6.2 (0.8) | <0.0001 |
| I feel confident seeking plastic surgery resident mentorship | 4.7 (1.5) | 5.4 (1.2) | <0.0001 |
| I feel comfortable seeking plastic surgery faculty mentorship | 4.6 (1.7) | 5.3 (1.3) | <0.0001 |
| I am confident in receiving and incorporating feedback | 6.2 (0.8) | 6.5 (0.6) | 0.005 |
| I am confident providing others with constructive feedback | 5.5 (1.3) | 5.5 (1.3) | 0.63 |
Residents
Both junior and senior residents, respectively, noted increased confidence marking surgical incisions (3.1 versus 5.6, P < 0.0001; 4.9 versus 6.2, P < 0.0001), identifying neurovascular structures (3.5 versus 5.6, P < 0.0001; 4.9 versus 6.1; P < 0.0001), completing procedures (2.0 versus 4.3, P < 0.0001; 4.0 versus 5.6, P < 0.0001), and teaching medical students (2.1 versus 4.3, P < 0.0001; 3.8 versus 5.5, P < 0.0001). For a full breakdown of Likert-scale data for residents, refer to Table 3. Although all residents reported increased confidence both in performing the procedures and in teaching ability, there was no statistically significant difference in the Accreditation Council for Graduate Medical Education milestone evaluations between the 2023–2024 MCC residents and the 2022–2023 residents who did not participate in the MCC (Table 4).
Table 3.
Prelaboratory and Postlaboratory Surveys of Residents, Stratified by Level of Training (Junior Versus Senior), With Answers Based on a 7-point Likert Scale
| Prelaboratory, Mean (SD) | Postlaboratory, Mean (SD) | P | |
|---|---|---|---|
| I am interested in specializing in hand and upper extremity surgery | |||
| Junior residents | 3.7 (1.8) | 4.0 (2.0) | 0.0044 |
| Senior residents | 2.6 (2.1) | 2.6 (2.0) | 0.86 |
| I am interested in specializing in craniofacial surgery | |||
| Junior residents | 1.8 (0.9) | 1.9 (0.8) | 0.66 |
| Senior residents | 1.8 (0.9) | 1.8 (1.0) | 0.77 |
| I am interested in specializing in microsurgery | |||
| Junior residents | 5.1 (0.9) | 5.2 (0.9) | 0.19 |
| Senior residents | 2.2 (1.7) | 2.4 (1.7) | 0.09 |
| I am able to list the indications for the procedure performed in this laboratory | |||
| Junior residents | 4.0 (1.3) | 5.7 (0.7) | <0.0001 |
| Senior residents | 5.3 (1.3) | 6.3 (0.8) | <0.0001 |
| I can confidently mark surgical incision sites for the procedure performed in this laboratory | |||
| Junior residents | 3.1 (1.4) | 5.6 (0.9) | <0.0001 |
| Senior residents | 4.9 (1.1) | 6.1 (0.9) | <0.0001 |
| I am confident I know the anatomical structures that need to be identified in this laboratory | |||
| Junior residents | 3.5 (1.5) | 5.6 (0.8) | <0.0001 |
| Senior residents | 4.9 (1.1) | 6.1 (0.9) | <0.0001 |
| I can confidently and safely expose the relevant anatomical structures in this laboratory | |||
| Junior residents | 2.7 (1.2) | 5.1 (0.9) | <0.0001 |
| Senior residents | 4.6 (1.6) | 6.0 (1.0) | <0.0001 |
| I can confidently perform this procedure from start to finish | |||
| Junior residents | 2.0 (1.0) | 4.3 (1.3) | <0.0001 |
| Senior residents | 4.0 (1.6) | 5.6 (1.4) | <0.0001 |
| I can confidently teach a medical student this procedure | |||
| Junior residents | 2.1 (1.1) | 4.3 (1.3) | <0.0001 |
| Senior residents | 3.8 (1.8) | 5.5 (1.4) | <0.0001 |
| I am confident receiving and incorporating feedback | |||
| Junior residents | 5.5 (1.1) | 6.2 (0.6) | 0.0013 |
| Senior residents | 5.1 (1.3) | 6.0 (0.8) | <0.0001 |
| I am confident in providing others with constructive feedback | |||
| Junior residents | 4.6 (1.3) | 5.7 (1.0) | <0.0001 |
| Senior residents | 4.9 (1.4) | 5.8 (1.0) | <0.0001 |
Table 4.
Comparison of Average Resident Surgical and Teaching Milestone Scores as Determined by Anonymous Faculty Members’ Evaluations Between the 2022–2023 and 2023–2024 AYs
| AY 2022–2023, Mean (SD) | AY 2023–2024, Mean (SD) | P | |
|---|---|---|---|
| Surgical care—manages complicated surgical patients and surgical service, can progress through operations | |||
| PGY1 | 1.8 (0.1) | 1.5 (0.1) | 0.19 |
| PGY2 | 2.5 (0) | 2.4 (0.1) | 0.67 |
| PGY3 | 3.2 (0.2) | 3.3 (0.3) | 0.91 |
| PGY4 | 3.6 (0.3) | 3.9 (0.3) | 0.30 |
| PGY5 | 4.3 (0.3) | 4.1 (0.2) | 0.53 |
| Tissue transfer—routine: skin grafts, local tissue rearrangement. Complex: pedicled flaps, free flaps, manages complications | |||
| PGY1 | 1.8 (0.1) | 1.4 (0.1) | 0.09 |
| PGY2 | 2.5 (0) | 2.4 (0.2) | 0.66 |
| PGY3 | 3.2 (0.2) | 3.3 (0.3) | 0.31 |
| PGY4 | 3.5 (0.2) | 3.9 (0.2) | 0.10 |
| PGY5 | 4.3 (0.3) | 4.2 (0.3) | 0.56 |
| Research and teaching—spans educating patients and families to teaching team members to colleagues; understanding basic biostatistics to critically evaluating evidence to completing a project from concept to manuscript | |||
| PGY1 | 1.9 (0) | 1.7 (0.1) | 0.12 |
| PGY2 | 2.8 (0.2) | 3.0 (0) | 0.44 |
| PGY3 | 3.4 (0.4) | 3.8 (0.4) | 0.32 |
| PGY4 | 3.6 (0.2) | 4.1 (0.3) | 0.11 |
| PGY5 | 4.3 (0.1) | 4.3 (0.4) | 0.86 |
AY, academic year; PGY, postgraduate year.
Faculty
Faculty reported an increase in overall confidence in teaching ability (6.2 versus 6.5, P = 0.006), in addition to providing others with constructive feedback (6.2 versus 6.5, P = 0.032) (Table 5). Furthermore, faculty received higher average scores on their yearly evaluations after MCC participation, particularly in regard to improving quality of care through evaluation of results (4.5 ± 0.2 versus 4.6 ± 0.3; P = 0.017), providing professional guidance when needed (4.5 ± 0.3 versus 4.7 ± 0.3; P = 0.012), and promoting an environment of inquiry (4.4 ± 0.3 versus 4.6 ± 0.3; P = 0.0063) (Table 6).
Table 5.
Prelaboratory and Postlaboratory Surveys of Faculty, With Answers Based on a 7-point Likert Scale
| Prelaboratory, Mean (SD) | Postlaboratory, Mean (SD) | P | |
|---|---|---|---|
| I am confident in my ability to actively guide a learner through a surgical procedure | 6.5 (0.5) | 6.5 (0.6) | 0.66 |
| I am confident in my ability to verbally guide a learner through a surgical procedure | 6.4 (0.6) | 6.4 (0.5) | 0.43 |
| I am confident of letting my assigned learner perform this procedure in the OR under appropriate guidance | 5.9 (1.0) | 6.3 (0.6) | 0.019 |
| I am overall confident of my teaching ability | 6.2 (0.4) | 6.5 (0.5) | 0.006 |
| I am confident in providing others with constructive feedback | 6.2 (0.6) | 6.5 (0.5) | 0.032 |
| I am confident receiving and incorporating feedback | 6.1 (0.9) | 6.4 (0.6) | 0.029 |
| I am confident in my ability to adapt my teaching style to benefit different types of learners | 5.9 (0.9) | 6.2 (0.7) | 0.15 |
Table 6.
Comparison of Average Faculty Members’ Evaluations as Determined by Anonymous Resident Responses Between the 2022–2023 and 2023–2024 AYs
| AY 2022–2023, Mean (SD) | AY 2023–2024, Mean (SD) | P | |
|---|---|---|---|
| Expectations are appropriate | 4.4 (0.3) | 4.6 (0.3) | 0.055 |
| Expectations are clearly defined | 4.5 (0.3) | 4.6 (0.3) | 0.16 |
| Faculty available to you when you need them | 4.5 (0.3) | 4.6 (0.2) | 0.13 |
| Faculty continues to improve quality of care through evaluation of results | 4.5 (0.2) | 4.6 (0.3) | 0.017 |
| Faculty contributes to a positive learning environment | 4.5 (0.3) | 4.5 (0.2) | 0.97 |
| Faculty deals with residents effectively, respectfully, and appropriately | 4.5 (0.3) | 4.5 (0.3) | 0.87 |
| Faculty demonstrates appropriate professional behavior | 4.5 (0.3) | 4.6 (0.3) | 0.088 |
| Faculty provides adequate professional guidance when needed | 4.5 (0.3) | 4.7 (0.3) | 0.012 |
| Faculty demonstrates respect for residents, patients, and healthcare colleagues | 4.5 (0.3) | 4.7 (0.3) | 0.058 |
| Faculty effectively demonstrates evidence to support clinical decisions | 4.4 (0.3) | 4.5 (0.4) | 0.17 |
| Faculty encourages appropriate use of consults and ancillary services | 4.4 (0.3) | 4.5 (0.4) | 0.54 |
| Faculty promotes an environment of inquiry | 4.4 (0.3) | 4.6 (0.3) | 0.0063 |
| Faculty sincerely interested in professional development of residents | 4.5 (0.3) | 4.6 (0.3) | 0.062 |
| Plastic surgery patient management effectively taught | 4.4 (0.2) | 4.4 (0.4) | 0.50 |
| Principles of plastic surgery effectively taught | 4.5 (0.3) | 4.5 (0.3) | 0.90 |
| Provides up-to-date information and data | 4.4 (0.3) | 4.5 (0.3) | 0.55 |
| Surgical technique in OR effectively taught | 4.5 (0.2) | 4.5 (0.3) | 0.46 |
Although several statistically significant increases were noted, including providing professional guidance and promoting an environment of inquiry, these differences were likely not clinically significant given the small variance in the results.
AY, academic year.
DISCUSSION
The MCC is a resource-sharing curriculum that simultaneously benefits medical students, residents, and faculty. As demonstrated by our data, learners at all levels honed their operative abilities, teaching skills, and interpersonal communication skills through the use of this novel cadaveric curriculum. Notably, this initiative is the first in the literature to use a cadaveric model specifically to advance the surgical teaching abilities of both residents and faculty, highlighting the need for ongoing use of cadavers as a regular part of surgical education. Our model also demonstrates the methods by which cadaveric curricula can be made more cost-effective, particularly through the incorporation of additional surgical subspecialties.
A critique of current surgical clerkships is that medical students have minimal hands-on experience due to competition with residents for procedures or suturing opportunities, patient safety concerns, and fear of litigation.4–6 Hands-on practice with timely, personalized feedback is the most valuable way for a trainee to learn, particularly when developing technical skills.23 Our data from the MCC reinforced this principle, as students reported significantly higher comfort with their technical skills and the OR in general after laboratory participation. Furthermore, the MCC improved medical students’ confidence in seeking surgical mentorship. The historically negative stereotypes associated with surgery can create a culture of anxiety and fear for students as they enter the OR for the first time or seek a surgical mentor.27 With medical students across the country adjusting to the impact of Step 1 becoming pass/fail, there is a critical need to expand mentorship in the surgical education space to provide students with the exposure that they need to match into competitive surgical specialties.28 The MCC addressed this need by providing a safe surgical learning space, with medical students reporting significantly higher levels of confidence interacting with surgical residents and faculty after the laboratory sessions.
Consistent with the current literature, residents had an expected increase in their procedural ability after the laboratory session.7–9 However, no studies to date have investigated the potential benefits of using cadaveric models for residents or faculty to practice their teaching ability. Interestingly, despite senior residents and faculty being the planned instructors during the MCC, residents at all levels and faculty reported an increase in teaching ability during the laboratory. Junior residents organically began teaching medical students during the skin closures at the end of the dissections, providing tips and encouragement. This unexpected benefit not only improved medical student participation and mentorship but also provided junior residents with an early opportunity to improve their own teaching ability.
Our laboratory also demonstrated educational benefits for plastic surgery faculty members. These individuals are traditionally hired based on their clinical skills, whereas a majority of faculty members have little or no training in the practice of adult education.12,13 It has been reported that new plastic surgery faculty who are interested in improving their teaching ability find it difficult to balance learning to be good teachers with establishing their practice.13 The MCC addresses these gaps in education by (1) starting longitudinal teaching education earlier on for residents participating in the MCC and (2) providing faculty members a safe surgical space to focus on their teaching ability. Faculty members were noted to have statistical increases in self-reported overall teaching confidence, in addition to increases in promoting an environment of inquiry and providing professional guidance, demonstrating the positive effect of the MCC.
Although the MCC has multiple benefits, it can be logistically intimidating to implement such a collaborative event. Our first steps to creating this event entailed setting up a meeting with the Dean of Medical Education and the general surgery clerkship director to determine (1) medical students’ interest and availability for the MCC and (2) unused resources (ie, the number and type of cadavers that were not fully dissected, their associated disposal schedule, and available instrumentation). By using existing resources, the total cost for access to 6 soft-embalmed cadavers in the 2023–2024 academic year was $2000, with costs shared between the plastic surgery and general surgery departments. Without these collaborative methods, the cost for cadavers at our institution would have been $18,000, excluding storage fees. As these cadavers were purchased primarily for medical student education, many of the anatomical structures and flaps that were taught in the MCC were untouched, as they are not part of a standard anatomy laboratory curriculum. Standard instrumentation (ie, needle drivers, scissors, retractors) already present in the laboratory for medical student use was accessible for the MCC due to this collaboration. Certain dissections required more specialized tools, such as oscillating saws and osteotomes, with a 1-time equipment cost of $3000. Another typical barrier to cadaveric educational programming is proper upkeep. Despite proper cadaveric stewardship, several cadavers needed premature disposal secondary to decomposition. Rather than subsequently increasing the number of residents and medical students per cadaver, we chose to decrease the number of participants at these events to guarantee continued personalized education.
Our study was further limited by survey bias and the use of qualitative responses rather than quantitative data. To help address this limitation, we used medical students’ shelf scores, resident milestones, and faculty evaluations for additional evaluation of the laboratory’s benefit. Although there was no significant improvement noted on medical students’ shelf scores or resident milestones, we believe the Likert data, coupled with consistently positive experiences from learners at all levels, sufficiently demonstrate the value for medical students, residents, and faculty members alike. However, we do acknowledge that the short-term nature of this study did not allow for proper investigation of the persistence of the educational benefits over time, which is the ongoing focus of current studies in our group as we enter our fourth year of the MCC.
Additionally, the current methodology now suggests that the apprenticeship model “see one, do one, teach one” on which our curriculum is based can be considered outdated, as patient safety research shows it can push trainees to perform procedures on live patients before they have demonstrated competence or received adequate supervision.24,29 However, cadaver-based initiatives, such as the MCC proposed here, offer a safer alternative to practice in the clinical environment, giving learners unlimited opportunities for deliberate practice without clinical consequences. Still, even the gold-standard fidelity of cadaveric dissection cannot replicate the physiological stressors, team dynamics, and time pressures of the OR. Accordingly, cadaver work should complement, not replace, competency-based programs that blend simulation, graded responsibility, and rigorous performance assessment in the clinical setting to ensure that students and residents advance once they have met explicit benchmarks.
Based on the preliminary success of the MCC, this teaching model has been expanded to include other surgical subspecialties in the next academic year (Fig. 2). Although the expansion has resulted in a higher level of organization to ensure that desired procedures are timed appropriately (ie, plastic surgery department to perform radial forearm flap dissection before hand/forearm tendon repair by the orthopedic surgery department), it ensures multidepartmental “buy-in” and guarantees improved, low-cost cadaveric access for learners for years to come. Expansion efforts to include the departments of neurosurgery and otolaryngology would be routes for further cost reduction in the future.
Fig. 2.
Proposed schedule for use of the cadaveric curriculum across multiple surgical subspecialties. ALT, anterolateral thigh; AVF, anterolateral thigh.
CONCLUSIONS
The novel MCC developed at our institution significantly enhances surgical education for medical students, residents, and faculty members through hands-on, peer-to-peer learning. Our findings show that this cadaveric model not only boosts procedural skills but also fosters improved teaching abilities across all levels, from junior residents to senior faculty members. This is the first model in the literature to use cadaveric dissection to advance surgical teaching skills across all education levels, demonstrating its potential as an indispensable tool in surgical training. The success of the MCC also emphasizes the feasibility of creating cost-effective, multispecialty cadaveric programs, paving the way for a more collaborative, sustainable approach to surgical education. Future expansions to other departments hold great promise for further enhancing education outcomes and building a more integrated, resource-efficient medical education system.
DISCLOSURES
The authors have no financial interest to declare in relation to the content of this article. This project was funded by the American Foundation for Surgery of the Hand via the 2023 Resident and Fellow Fast Track Grant. Additionally, Bird declares that research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under the award number TL1TR002368. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
ACKNOWLEDGEMENTS
The authors acknowledge Kate Sanner-Dixon, MD, Sarah Adkins, BS, and Stephen Douglas, BS, for assistance with planning and execution of the 2023–2024 academic year cadaveric laboratories. In addition, the authors also acknowledge the following faculty members for volunteering their time to participate in 1 or more laboratories throughout the year: Dhaval Bhavsar, MBBS; Jacob Brubacher, MD; Matthew Drake, MD; Michelle De Souza, MD; Charles Jehle, MD; Richard Korentager, MD, FACS; Michael Lypka, MD, DMD, FACS, FAAP, FRCD(C); Duncan Nickerson, MD, FRCSC, FACS, FABA; and Julia Slater, MD.
Footnotes
Published online 10 September 2025.
Disclosure statements are at the end of this article, following the correspondence information.
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